Antiseptic-impregnated Catheters Research Articles

Could niaouli aromatherapy oil be an option in the treatment of urinary tract infections in hemiplegic patients?

Aim: Stroke remains a massive public health burden, affecting approximately 795,000 individuals each year. It is the leading cause of long-term disability in adults and the third leading cause of death in developed countries. After a stroke, medical complications are common and can prolong hospital stay, worsen stroke outcomes, and increase the cost of care. The most common medical complications related to stroke are infections, including pneumonia and urinary tract infection (UTI). Intervention strategies previously investigated in these cases and other patient populations include prophylactic antibiotics, antiseptic-impregnated catheters, and quality improvement interventions to reduce inappropriate catheterization. In addition, in recent years, complementary and alternative medicine methods, such as Melaleuca viridiflora (also known as tea tree or Niaouli oil) have become increasingly popular. The primary uses of this oil have historically been associated with the antiseptic and anti-inflammatory effects of this plant. In this study, we investigated the efficacy of M. viridiflora (Niaouli) oil in the treatment of UTIs in stroke patients.Material and Method: We did not find any study in the literature on the effects of Niaouli aromatherapeutic oil on UTIs, which are common in hemiplegic patients; therefore, we planned the current study. The hospital records were screened to identify patients treated at the Physical Therapy and Rehabilitation Unit of Health Sciences University Adana City Training and Research Hospital, who were diagnosed with UTIs during their follow-up and recommended Niaouli aromatherapy oil as a complementary treatment. The oil was supplied by the patients themselves. As the method of use, the patients were asked to prepare a washing solution by dripping 10 drops of Niaouli oil into 1 liter of water. The patients were recommended to wash the perineum area three times a day with this solution for 20 days.Results: The mean age of the hemiplegic patients evaluated in the study was 51.55±19.20 (min=18, max=77) years. Of the patients, 72.7% were male, 42.4% had an American Spinal Injury Association classification of C, 54.5% had spontaneous bladder emptying, and 30.3% had stage 1, 21.1% had stage 2, and 3.0% had stage 3 spasticity. Leukocyte esterase and leukocyte in urine and sedimentation values​ statistically significantly decreased in the post-treatment period compared to the pre-treatment period.Conclusion: UTI is a common complication in stroke patients. In this study, it was determined that the efficacy of the treatment of UTIs increased, and the use of antibiotics significantly decreased with the utilization of the fungicidal and bactericidal effects of M. viridiflora (Niaouli) aromatherapy oil.

Impact of mupirocin and betadine-impregnated urethral catheter on the incidence rate of catheter-related bacteriuria and urinary tract infections, in comparison with conventional catheterization

Introduction: One of the most common nosocomial infections is urinary tract infection (UTI), which more commonly seen in patients with urethral catheter. Inappropriate use of urinary catheter can lead to certain complications including infection. Objectives: The aim of this study was to evaluate the effect of using mupirocin and betadineimpregnated urethral catheters in comparison with conventional catheterization on the incidence rate of catheter-related bacteriuria (CRB) and UTIs. Patients and Methods: In this parallel randomized clinical trial, phase III, a total of 150 patients (male and female) ranging from 18-75 years who needed urinary catheterization were randomly assigned into three evenly distributed groups; betadine, mupirocin, and conventional (control) through permuted block randomization. Sterile urine samples were examined for bacteriuria after catheter insertion and at the time of catheter removal. Results: The mean age of the patients was 49.81 (±15.11) years. UTI was seen most frequently in the conventional group (56%), and least frequently in the mupirocin group (24%) (P<0.004). A significant difference was observed in incidence of post-catheterization UTI between the conventional and mupirocin groups, as well as between the conventional and betadine groups (P=0.001 and P=0.04, respectively). Conclusion: Using antibiotic and antiseptic-impregnated catheters (both mupirocin and betadine) could help to decrease the incidence rate of UTI in comparison to the conventional catheterization. Trial registration: The trial was registered with the TCTR ID: TCTR20200627001 (http:// www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=s earch&task2=view1&id=6442).

Types of indwelling urinary catheters for long-term bladder drainage in adults

Prolonged urinary catheterization is common amongst people in long-term care settings and this carries a high risk of developing a catheter-related urinary tract infection and associated complications. A variety of different kinds of urethral catheters are available. Some have been developed specifically to lower the risk of catheter-associated infection, for example antiseptic or antibiotic impregnated catheters. Ease of use, comfort and handling for the caregivers and patients, and cost-effectiveness are also important factors influencing choice. The primary objective was to determine which type of indwelling urinary catheter is best to use for long-term bladder drainage in adults. We searched the Cochrane Incontinence Group Specialised Register (last searched 31 March 2011), which includes searches of CENTRAL, MEDLINE and handsearching of journals and conference proceedings, and the reference lists of relevant articles. All randomised trials comparing types of indwelling urinary catheters for long-term catheterization in adults. Long-term catheterization was defined as more than 30 days. Data extraction has been undertaken by two review authors working independently and simultaneously. Any disagreement has been resolved by a third review author. The included trial data were handled according to the methods of the Cochrane Handbook for Systematic Reviews of Interventions. Three trials were included, involving 102 adults in various settings. Two trials had a parallel group design and one was a randomised cross-over trial.Only two of the six targeted comparisons were assessed by these trials: antiseptic impregnated catheters versus standard catheters (one trial) and one type of standard catheter versus another standard catheter (two trials).The single small cross-over trial was inadequate to assess the value of silver alloy (antiseptic) impregnated catheters. In the two trials comparing different types of standard catheters, estimates of differences were all imprecise because the trials also had small sample sizes; confidence intervals (CI) were too wide to rule out clinically important differences. One trial did suggest, however, that the use of a hydrogel coated latex catheter rather than a silicone catheter may be better tolerated (risk ratio (RR) for need for early removal 0.41, 95% CI 0.22 to 0.77). The updated search could not reveal any additional evidence. Very few trials have compared different types of catheter for long-term bladder drainage. All trials were small and showed methodological weaknesses. Therefore, the evidence was not sufficient as a reliable basis for practical conclusions. Further, better quality trials are needed to address the current lack of evidence in this clinically important area.

Prevención de la infección asociada a catéteres: utilidad y costo-eficacia de los catéteres con antisépticos en pediatría

ABSTRACT Prevention of catheter-related infection; usefulness and cost-effectiveness of antiseptic catheters in children Objective: To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conven-tional catheters in preventing catheter-related blood stream infections (CR-BSI). Design: Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and Methods: A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatria “Prof. Dr. Juan P. Garrahan”, since September 2005 to December 2007. Demographic and CVC data were re-trieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention: CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs control group: CVC without antiseptics (conventional).

Prevention of catheter-related infection: usefulness and cost-effectiveness of antiseptic catheters in children

To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter- related blood stream infections (CR-BSI). Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods. A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic- impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 dayscatheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1- 48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.

Types of urethral catheters for management of short-term voiding problems in hospitalized adults: a short version Cochrane Review

Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No: CD004013. DOI: 10.1002/14651858.CD004013.pub3. Copyright O 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This article is reproduced with the kind permission of the authors and the publisher. Background: Urinary tract infection (UTI) is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialized urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and cost. Objectives: The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterization. Methods: We searched the Specialized Trials Register of the Cochrane Incontinence Group (searched September 11, 2007). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials. All randomized and quasi-randomized trials comparing types of indwelling urinary catheters for short-term catheterization in hospitalized adults. Shortterm catheterization was defined as up to and including 14 days, or other temporary short- term use as defined by the trialists (for example Results: Twentythree trials met the inclusion criteria involving 5,236 hospitalized adults in 22 parallel group trials and 27,878 adults in one large cluster-randomized cross-over trial. The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterized hospitalized adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68-1.15) and these catheters are no longer available. Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.54, 95% CI 0.43-0.67) in hospitalized adults catheterized for 1 week of catheterization the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.64, 95% CI 0.51- 0.80). The randomized cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3% and 35.5%. Antibiotic impregnated catheters were compared to standard catheters and found to lower the rate of asymptomatic bacteriuria in the antibiotic group at 1 week the results were not statistically significant. One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03- 1.63). Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection. Individual trials were too small to show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. Conclusions: The results suggest that the use of silver alloy indwelling catheters for catheterizing hospitalized adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters. Catheters impregnated with antibiotics are also beneficial in reducing bacteriuria in hospitalized adults catheterized for Neurourol. Urodynam. 27:738-746, 2008. a2008 Wiley-Liss, Inc. Key words: UTI; urethral, catheter; short-term DOI: 10.4038/sljog.v31i2.1756 Sri Lanka Journal of Obstetrics and Gynaecology 2009; 31 : 110-121

Urinary Tract Infections Complicating Stroke

Hospital-acquired urinary tract infection (UTI) is a common complication in hospitalized patients. Recently, catheter-associated UTI has been identified by the Centers for Medicare and Medicaid Services as a preventable condition, and additional payments to hospitals for its treatment are now declined, increasing the need for prevention of this important complication. This article explores in-depth the pathophysiology, risk factors for, and consequences of UTI after stroke and possible methods to reduce its incidence in the stroke population. Patients with stroke are particularly vulnerable to UTI due to increased risk from immunosuppression, bladder dysfunction, and increased Foley catheter use; and the fever and systemic inflammatory response associated with UTI may impair stroke recovery. UTI is associated with poorer neurological outcomes, longer hospital stays, and increased cost of care after stroke. Intervention strategies previously attempted in this and other populations include prophylactic antibiotics, antiseptic-impregnated catheters, and quality improvement interventions to reduce inappropriate catheterization. Patients with stroke have different risks for, consequences of, and barriers to reducing UTI than other hospitalized patients. Further research is needed to develop an effective approach to decreasing this important complication in the stroke population.

Double-lumen central venous catheters impregnated with chlorhexidine and silver sulfadiazine to prevent catheter colonisation in the intensive care unit setting: a prospective randomised study

Antimicrobial- and antiseptic-impregnated catheters are strategies recommended to prevent central venous catheter (CVC) colonisation. Few data regarding chlorhexidine/silver sulfadiazine-impregnated catheters in intensive care unit (ICU) patients have been reported. We performed a prospective, randomised study comparing the colonisation rates of chlorhexidine/silver sulfadiazine-impregnated CVCs (group 1) against standard CVCs (group 2). In order to assess catheter colonisation rates, a 4cm segment from the tips of aseptically removed catheters was cultured by the roll-plate method. In all, 109 patients were enrolled with successful catheter insertion, 51 of them in group 1 and 58 in group 2. There were no statistically significant differences between the two groups with regards to age, Sequential Organ Failure Assessment (SOFA) score, ICU admission diagnosis, infection risk, catheter insertion sites or catheter length of stay. The colonisation rates were 29.4% (15 catheters) for group 1 and 34.5% (20 catheters) for group 2 (P=0.50). Double-lumen CVCs impregnated with chlorhexidine and silver sulfadiazine were not effective in reducing the incidence of catheter colonisation in ICU patients.

Catheter-Related Bloodstream Infection in the Intensive Care Unit

Catheter-related bloodstream infection (CRBSI) is a significant cause of morbidity and mortality in the intensive care unit, contributing to prolonged stay with the associated cost and resource implications. Various mechanisms of infection have been suggested, and consequently, numerous interventions to reduce the burden of infection have been proposed, the efficacy of most of which remains controversial. The practice of routine catheter change and preferential use of the subclavian vein insertion site are both associated with an increased risk of mechanical complications, which may outweigh any potential benefit. Additionally, the use of silver- and antiseptic-impregnated catheters, of questionable benefit in the ICU patient population, is also argued to be unjustified in terms of efficacy and cost. A small scale study in a London university district general hospital ICU found that while infection rates were low, the majority of infections were caused by Staphylococcus epidermidis and thus were probably a result of contamination either from the patient's commensal flora or acquired by contamination from healthcare workers. In accordance with published findings, this suggests that preventing contamination will decrease infection rates. Strict aseptic technique and the use of sterile fields during insertion are most likely the main contributors in reducing rates of infection. This together with education of staff across disciplines and adherence to local guidelines are likely to be the mainstays of reducing CRBSI in the ICU.

Efficiency of rifampicin–miconazole-impregnated catheters in the femoral venous site

The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial or antiseptic-impregnated catheter for short-term catheterization and recommend avoiding femoral access to reduce the risk of central venous catheter-related bacteremia (CVC-RB). The objective of this study was to determine the incidence of CVC-RB with rifampicin–miconazole-impregnated catheters (RM-C) and standard catheters (S-C) in femoral venous access; and the cost of CVC-RB with both types of catheter.

The Use of Rifampicin‐Miconazole–Impregnated Catheters Reduces the Incidence of Femoral and Jugular Catheter‐Related Bacteremia

The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial- or antiseptic-impregnated catheter for short-term use. In previous studies, we have found a higher incidence of central venous catheter-related bacteremia among patients with femoral and central jugular accesses than among patients with other venous accesses. The objective of our study was to determine the incidence of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters and standard catheters in patients with femoral and central jugular venous accesses. This was a cohort study, conducted in the 24-bed polyvalent medical-surgical intensive care unit of a university hospital. We included patients who were admitted to the intensive care unit from 1 June 2006 through 30 September 2007 and who underwent femoral or central jugular venous catheterization. We inserted 184 femoral (73 rifampicin-miconazole-impregnated catheters and 111 standard catheters) and 241 central jugular venous catheters (114 rifampicin-miconazole-impregnated catheters and 127 standard catheters). We found a lower rate of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters than with standard catheters among patients with femoral access (0 vs. 8.62 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.86; P = .03) and among patients with central internal jugular access (0 vs. 4.93 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.93; P = .04). Rifampicin-minonazole-impregnated catheters are associated with a statistically significant reduction in the incidence of catheter-related bacteremia in patients with short-term catheter use at the central jugular and femoral sites.

Types of urethral catheters for management of short‐term voiding problems in hospitalized adults: A short version cochrane review

Urinary tract infection (UTI) is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialized urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and cost. The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterization. We searched the Specialized Trials Register of the Cochrane Incontinence Group (searched September 11, 2007). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials. All randomized and quasi-randomized trials comparing types of indwelling urinary catheters for short-term catheterization in hospitalized adults. Short-term catheterization was defined as up to and including 14 days, or other temporary short-term use as defined by the trialists (for example <21 days with data time points at 7-day intervals). Data were extracted by one reviewer and independently verified by a second reviewer for both the original review and for the update. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Where data in trials were not fully reported, clarification was sought directly from the trialists (secondary sources were used to confirm results of one trial). Twenty-three trials met the inclusion criteria involving 5,236 hospitalized adults in 22 parallel group trials and 27,878 adults in one large cluster-randomized cross-over trial. The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterized hospitalized adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68-1.15) and these catheters are no longer available. Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.54, 95% CI 0.43-0.67) in hospitalized adults catheterized for <1 week. At >1 week of catheterization the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.64, 95% CI 0.51-0.80). The randomized cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3% and 35.5%. Antibiotic impregnated catheters were compared to standard catheters and found to lower the rate of asymptomatic bacteriuria in the antibiotic group at <1 week of catheterization for both minocycline and rifampicin combined (RR 0.36, 95% CI 0.18-0.73), and nitrofurazone (RR 0.52, 95% CI 0.34-0.78). However, at >1 week the results were not statistically significant. One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03-1.63). Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection. Individual trials were too small to show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. The results suggest that the use of silver alloy indwelling catheters for catheterizing hospitalized adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters. Catheters impregnated with antibiotics are also beneficial in reducing bacteriuria in hospitalized adults catheterized for <1 week but the data were too few to draw conclusions about those catheterized for longer. There was not enough evidence to suggest whether or not any standard catheter was better than another in terms of reducing the risk of urinary tract infection in hospitalized adults catheterized short-term. Siliconized catheters may be less likely to cause urethral side effects in men; however, this result should be interpreted with some caution as the trials were small and the outcome definitions and specific catheters compared varied.

Guidelines for Management of Home Parenteral Support in Adult Chronic Intestinal Failure Patients

Management of home parenteral support in adult benign but chronic intestinal failure patients requires a nutrition support team using disease-specific pathways. Education of patients to ensure they self manage home parenteral nutrition (HPN) is cornerstone to obtain minimal rate of technical complications and improvement in quality of life. Nutritive mixtures, compounded by pharmacists in single "all-in-one" bags, must be tailored according to the nutritional and intestinal status of individual patients with definition of macronutrients and water-electrolyte needs, respectively. Each PN cycle should be complete in essential nutrients to be nutritionally efficient and should have sufficient amounts of amino acids, dextrose, water, minerals, and micronutrients to avoid deficiency. When the nutritional goal is achieved, a minimum number of PN cycles per week should be implemented, guided ideally by digestive balance(s) (In-Out) of macronutrients and minerals of individual patients. Indeed, HPN is, in most cases, a complementary nonexclusive mode of nutritional support. In short gut patients--who represent 75% of chronic intestinal failure patients--encouraging enteral feeding decrease PN delivery and the risk of metabolic liver disease associated with HPN. In short gut patients with no severe renal impairment, blood citrulline dosage, in association with the remnant anatomy, is a tool to delineate transient from permanent intestinal failure. The latter group includes candidates for trophic gut factors and rehabilitative or reconstructive surgery, including intestinal transplantation. Thus, outcome improvement for intestinal failure patients needs intestinal failure teams having expertise in all medical and surgical aspects of this field.

Central Venous Catheter Colonization in Critically Ill Patients: A Prospective, Randomized, Controlled Study Comparing Standard with Two Antiseptic-Impregnated Catheters

In this prospective, randomized, controlled, unblinded study, we compared colonization rates of a standard, unimpregnated central venous catheter (CVC) with rates for silver-coated and chlorhexidine-silversulfadiazine (CH-SS)-impregnated CVC. Patient characteristics, CVC insertion site, indwelling time, and colonization detected by semiquantitative and quantitative microbiologic techniques were documented. Two-hundred-seventy-five critically ill patients were included into the study protocol. One-hundred-sixty standard, 160 silver (S)-coated, and 165 externally impregnated CH-SS CVC were inserted. There was a significant difference in CVC colonization rates among study groups (P = 0.029). There was no difference in the colonization rate and the colonization per 1000 catheter days between standard and S-coated (P = 0.564; P = 0.24) or CH-SS-coated CVC (P= 0.795; P = 0.639). When comparing antiseptic CVC with each other, colonization rates were significantly less with CH-SS-impregnated than with S-coated CVC (16.9% versus 7.3%; P = 0.01; 18.2 versus 7.5 of 1000 catheter days; P = 0.003; relative risk, 0.43; 95% confidence interval, 0.21-0.85). Whereas standard and S-coated CVC were first colonized 2 and 3 days after insertion, respectively, CH-SS CVC were first colonized only after 7 days. In conclusion, antiseptic-impregnated CVC could not prevent catheter colonization when compared with standard polyurethane catheters in a critical care setting with infrequent catheter colonization rates and CVC left in place for >10 days.

Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.

Short‐Term Indwelling Catheters (A Systematic Review): Evidence for a Primarily Nursing Decision

ABSTRACT Program Overview: Urinary tract infection is the most common infection acquired by patients in hospital. The major associated cause is the presence of indwelling urinary catheters. A variety of specialised urethral catheters have been specifically designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Catheter choice or selection is primarily a nursing decision, and nurses also take a leading role in decision‐making regarding catheters purchased for hospitals. Methods: A systematic review (including metanalyses) was completed with the Cochrane Incontinence Review Group. Eighteen studies met the inclusion criteria: antiseptic impregnated catheters versus standard catheters, which included silver oxide (n = 3 trials) and silver alloy (n = 8 trials), antibiotic impregnated catheters versus standard catheters (n = 1 trial), and comparisons of different types of standard catheters (n = 6 trials). Results: Silver oxide catheters were not found to prevent bacteriuria in short‐term catheterised hospitalised adults (RR 0.87, 95% CI 0.68 to 1.13). Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.36, 95% CI 0.25 to 0.52.) in hospitalised adults catheterised for less than 1 week. At greater than 1‐week catheterization, the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.67, 95% CI 0.50 to 0.90). The risk of symptomatic urinary tract infection was also found to be reduced with the use of silver alloy catheters (RR 0.60, 95% CI 0.50 to 0.73). Silver alloy indwelling catheters appear to reduce the risk of catheter‐acquired urinary tract infection in hospitalised adults catheterised short term. Cost‐benefit analyses indicate that compensation for increased cost of silver alloy catheters would come from the reduction in the cost of catheter‐acquired urinary tract infection. Conclusions: This review provides not only nurses and nurse managers, but also other health professionals with evidence of effectiveness to influence catheter choice.

Types of urethral catheters for management of short-term voiding problems in hospitalised adults.

Types of urethral catheters for management of short-term voiding problems in hospitalised adults.

Effect of central venous catheter type on infections: a prospective clinical trial

This study reports on a block clinical trial of two types of central venous catheters (CVCs): antiseptic-impregnated catheters (AIC) and non-impregnated catheters (non-AIC), on catheter tip colonization and bacteraemia. In total, 500 catheters were inserted in 390 patients over the 18 month study period, 260 (52.0%) AIC and 240 (48.0%) non-AIC. Of these, 460 (92.0%) tips (237 AIC and 223 non-AIC) were collected. While significantly fewer AIC, 14 (5.9%), than non-AIC, 30 (13.5%), catheters were colonized ( P<0.01), there was no difference in the rates of bacteraemias in the two groups (0.8% vs. 2.7%, respectively, P=0.16). There were 6.87 (95% CI 3.38–14.26) and 16.92 (95% CI 10.61–27.12) colonized AIC and non-AIC catheters, respectively, per 1000 catheter days, a difference that was significant ( P<0.01). However, no difference emerged between bacteraemias in AIC and non-AIC catheters per 1000 catheter days measured at 0.98 (95% CI 0.24–5.54) and 3.38 (95% CI 1.29–9.34), respectively ( P=0.10). Of the 444 CVCs that were sited in the subclavian or jugular veins and had tips collected, significantly more catheters were colonized in the jugular group, 19 (20%), compared with the subclavian group, 24 (6.9%; P≤0.01). Overall, the low rates of colonization and bacteraemia may be explained by the population studied, the policies used and the employment of a clinical nurse dedicated to CVC management.

The efficacy of an antiseptic-impregnated catheter on catheter-related bloodstream infection in the ICU

The efficacy of an antiseptic-impregnated catheter on catheter-related bloodstream infection in the ICU

Evidence-based prevention of catheter infection during parenteral nutrition.

Parenteral nutrition is a risk factor for catheter-related bloodstream infection. Here we reviewed strategies for the prevention of catheter-related infections, which always must begin with the cornerstone of prevention: the strict adherence to aseptic techniques. Most research has been interested in coated catheters. From these results, it may be concluded that antibiotics or antiseptic-impregnated catheters, like those with minocycline-rifampicin or chlorhexidine/silver sulfadiazine, significantly reduce catheter-related blood stream infections. Antibiotics or antiseptic-impregnated central venous catheters may even result in cost saving in intensive care units. Antiseptic or antibiotic-lock techniques would also be of interest to prevent catheter-related sepsis in high-risk patients who are receiving parenteral nutrition.